Effects of continued positioning pillow use until a corrected age of six months on cranial deformation and neurodevelopment in preterm infants: A prospective case-control study

A systematic review of improved positions and supporting devices for premature infants in the NICU

“…The characteristics of the included studies regarding the improved position are shown in Table 1 . In the devices section, 4 were studies on the prevention of deformational plagiocephaly (DP) [ [31] , [32] , [33] , [34] ], and 3 aimed to provide more comprehensive surroundings and comfort for infants [ [35] , [36] , [37] ]. The characteristics of the included studies on positioning devices are shown in Table 2 .…”

“… Emesis events were evenly distributed in both groups, the median hours per day on the cranial cup was 10.7, and group 2 had fewer abnormal cranial measures. 2020-Uchio et al [ 34 ] A case-control study with 19 subjects. <1800 g, <37 weeks Group 1: infants used this special pillow for at least 8 h a day from discharge to a corrected age of six months.…”

“…One study compared the effects of a special pillow and a regular pillow on the cranial deformity and neurodevelopment in preterm infants, which was long enough from discharge to a corrected age of 6 months, the special pillow significantly reduced DP, improved cognition and fine motor ability, and reduced asymmetric motor function [ 34 ]. The remaining three articles on the prevention of cranial deformities were from the same team: two were prospective, descriptive pilot studies [ 31 , 32 ], and one was a stratified, randomized single-blinded study [ 33 ].…”

“…We used the PEDro scale to evaluate the quality of the eighteen articles; five were rated as fair quality [ 17 , 19 , 28 , 31 , 32 ], fourteen were rated as good quality [18] , [20] , [21] , [23] , [25] , [26] , [27] , [29] , [30] , [33] , [34] , [35] , [36] , [37] , two were rated as excellent quality [ 22 , 24 ]. Inclusion and exclusion criteria were well reported in all studies, only six studies used both random allocation and concealed allocation [ 22 , [24] , [25] , [26] , 33 , 37 ], all studies that grouped participants had baseline comparability, and none of the study operators could be blinded, as the operator must know the intervention of the infants.…”

“…Instead, the designer leaves a special concavity for the position of the head, making the infant's head or external occipital protuberance fit into the recessed area. In Uchio's study [ 34 ], a special pillow with concavity was used, such designs also appear in Wilbrand's research [ 53 ]. This concave design can better maintain the infant's head in a midline position, and distribute external pressure evenly on both sides of the skull.…”